JP3312071B2 - Surgical hooks for use in living eye surgery - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION The present invention comprises a hook element and a fixing element, the hook element having at least one end with a hook-shaped hooking part and a long guiding part for pulling the iris locally. Is slidably provided on the guide portion and the surgical hook inserted through the incision in the cornea is retained on the outer contour of the eye by a fixation element for use in living eye surgery. Related to surgical hooks.

[0002]

BACKGROUND OF THE INVENTION In ophthalmic surgery, the problem often arises that the patient does not respond to iris enlargement by drugs or the pupil is not sufficiently enlarged for surgery. Especially in the case of cataract surgery, it is necessary to ensure a sufficiently large and unchanged field of view for the surgeon for the operation of the anterior and posterior parts of the eye. To produce this field of view, it is known to grasp the iris and pull it outward for pupil enlargement by means of a plurality of surgical hooks (iris retractors) spaced from one another. In doing so, each individual surgical hook is inserted into an incision made in the cornea, positioned on the eye, and removed again after the operation.

For living eye surgery, US Pat.
No. 037,589 discloses a holding device formed as a wire framework. The holding device includes a first surgical hook adjustably provided in the slider and a second surgical hook fixed to pull the iris of the eye separately from the first surgical hook. ing. The second surgical hook has a straight member with bent hook portions at both ends. This member is provided with an adjustable disk made of a flexible material. in this case,
The incision provided for inserting the surgical hook into the cornea is sealed by the disc, thereby preventing the outflow of aqueous humor. In the case of this known surgical hook, the individual incisions formed through the cornea for insertion of the respective surgical hooks have relatively large dimensions, so that an undesired outflow of aqueous humor is obtained. The incision must be well sealed with a flexible disc to prevent the incision, and the surgical hook must be removed and then closed again by time-consuming suturing.

[0004] European Patent Application Publication No. 0502258.
Other surgical hooks are known from the specification for use during eye surgery of living organisms. The surgical hook includes a guide portion integrally formed with a hook portion, and a holding portion formed as a platelet slidable on the guide portion. In the case of this surgical hook, the clamping part, through which the guiding part is inserted, has an arc-shaped recess at least on the side facing the outer corneal contour. The clamping member is divided into two parts by this recess, thereby optimally adapting to the outer corneal contour.

[0005]

The problem underlying the present invention is to maintain the handling operability as accurately as possible, on the one hand, so that the iris is not damaged when pulled, and, on the other hand, without the use of additional seals. The purpose of the present invention is to improve and form the surgical hook so that it can be inserted into the incision in the cornea and removed again, without the need for subsequent suturing or the like.

[0006]

SUMMARY OF THE INVENTION According to the invention, this object is achieved in accordance with the invention in that the hook element is made of a flexible thermoplastic synthetic resin in which the hooking part is integrally formed, the hooking part having a limited rigidity at least in the bending range. With this rigidity, the resistance acting on the hooking part by further pulling the iris while the hooking part is hooked on the iris or acting on the hooking part by the cornea with the hooking part removed from the iris The problem is solved by the fact that when the surgical hook is withdrawn from the eye, the bending range of the hooked part can be bent and stretched in a sufficiently straight state by the resistance when the surgical hook is pulled out of the eye.

The surgical hook according to the invention has the advantage that only a small incision has to be made in the cornea for insertion into the eye. The incision is formed and dimensioned so that it does not require an additional sealing function by means of a locking element slidable on the guide member.

Within the scope of the present invention, it has been found that the thread-like guide portion of the surgical hook is self-sealingly surrounded by a corneal wall separated by an incision during the operation. The locally limited stiffness of the hook portion has the following additional advantages. That is, when a suitable tensile load is applied to the guide portion to remove the surgical hook, the hook-shaped hook portion is automatically opened, so that the hook element can be pulled out of the eye as a long thread. There is.
Furthermore, it has been found that after removing the surgical hook, the incision in the cornea is self-sealing closed, while at the same time preventing unwanted outflow of aqueous humor. Thus, additional suturing of the incision is no longer necessary. The thread-like guide portion, which is longer than the hook portion, has sufficient elasticity, so that the eye is not injured by an unexpected contact of the operator.

[0009] Other features according to the invention will be apparent from the description and the appended claims, taken in conjunction with the drawings.

[0010]

BRIEF DESCRIPTION OF THE DRAWINGS FIG. FIG.
FIG. 4 is an enlarged side view of a surgical hook element. During eye surgery, the surgical hook allows the iris to be grasped and pulled outward. As shown in FIG. 2, the surgical hook (iris retractor) includes a hook element 10 and a fixing element 20 slidably and fixedly mounted on the hook element.

The hook element 10 is made of a thread having a completely smooth surface and, as shown in FIG. 1, has a substantially long guide part 11 and a hook-shaped hook part 15.
Contains. The hook portion is provided at one end of the guide portion 11. The hook portion 15 includes a curved portion 12 and a leg 1 provided at a distance 14 from the guide portion 11.
It consists of three. This leg has an edge 13 'perpendicular thereto. The edge 13 'is formed as a particularly smooth and flat surface with respect to the leg 13. The hook portion 15 which is bent into a hairpin shape and is integrally formed with the guide portion 11 is, for example, a
1 is formed so as to extend in parallel.

FIG. 2 showing the entire surgical hook 25 is shown in FIG.
3 shows a hook element 10 and a fixing element 20 provided thereon. For example, a fixing element 20 formed as a disk and made of a flexible material has two holes 23, 23 'spaced apart from each other and through which the fixing element 20 passes, as shown in FIG. Have. These two holes 23, 23 '
Is provided such that the fixing element 20 can slide on the guide portion 11 of the hook element 10 in the direction of the double arrow X. In this case, as shown in FIG. 2, the fixing element 20 forms, on one side of the guide part 11, a contact part 22 having a substantially arc-shaped profile cross section and is spaced apart from each other on the other side of the guide part 11. And two parts 21, 21 'provided
Are formed so as to protrude. In order to slide the fixing element 20 on the guide part 11, the two parts 21, 21 'are compressed towards one another. Thereby, the holes 23, 23 '
The inner edge (not shown) of FIG. 1 releases the engagement with the guide portion 11 (not shown). When the two parts 21 and 21 'are separated, the fixing element 20 is self-tightening and the hook element 1
Fixed to 0.

FIG. 3 is a plan view of the surgical hook 25 viewed from the direction of the arrow III shown in FIG. In FIG.
The hook element 10 formed by the guide part 11 and the hook part 15 and the fixing element 20 provided thereon are shown. The holes 23, 23 'spaced apart from one another on the common axis of symmetry X' of the hook element 10 and the fixing element 20 are, in particular, provided on the guide part 11 with the hook element 20 self-tightening as described above. Are formed and dimensioned relative to the thread-shaped hook element 10 such that the two parts 21, 21 'can be adjusted on the guide part 11 in the direction of the double arrow X (FIG. 2) by compression. By separating the two parts 21, 21 ′, the fixing element 20 is held in a self-tightening manner, so that it can be arranged at any position on the guide part 11.

Thus, a relatively flexible yarn made of a thermoplastic synthetic resin having good surface slip properties, for example a polyamide yarn, is used to make the hook element 10. To form the shape of the hook element 10 shown in FIGS. 1 and 2, the yarn is formed by a suitable heat treatment.

In order to form the hook element 10, the polyamide yarn is mounted on a not-shown molding formed in conformity with the guide part 11 and the catch part 15.
It is subjected to heat treatment (temperature control) together with the compact. Due to the heat treatment, the polyamide yarn has a hook-like shape in the area of the hook portion 15, thereby obtaining local rigidity. The guide part 11 which is longer than the hook part 15 is sufficiently flexible after the heat treatment. The guide portion 11 is straight (FIG. 1) or, as shown schematically in FIG. 2, is formed in an arc with a relatively large radius.

The above-described heat treatment of the polyamide yarn provides the following local rigidity of the hook portion 15. That is, when resistance is generated by further pulling the guide portion 11 in the direction of the arrow Z, the rigidity is obtained such that the hook-shaped hook portion 15 is bent and stretched to sufficiently return to the original state.

The fixing element 20 is made of a flexible synthetic resin having good sliding properties, and can slide on the guide portion 11 of the hook element 10 with a sufficiently small force when the two portions 21 and 21 'are compressed. The fixing element 20 is made of, for example, transparent silicon (silicon rubber).

FIG. 4 is a schematic horizontal sectional view of the eye indicated generally by 1. In this figure, the cornea 2, the iris 3 having the areas 3 ', 3 ", the sclera 7, the crystalline lens 4, the pupil 4' and the ciliary ligaments 6, 6 'are shown.

For clarity of the invention, FIG. 4 shows a surgical hook 25 in which the curved portion 12 of the hook portion 15 is hooked in the area 3 "of the iris 3. The surgical hook 2
5 is a contact portion 2 of the fixing element 20 which sufficiently contacts the transition portion 5
2. The slightly arcuately flexible guide part 11 of the hook element 10 then conforms substantially to the outer contour of the sclera 7. In this way, even in the case where a plurality of surgical hooks 25 are arranged annularly apart from each other, a well-accessed surgical area is ensured, and the surgeon can guide the individual surgical hooks 25 at the time of surgery.
Is not caught. Inadvertent contact of the guide part 11 by the surgeon is compensated by the flexibility of the long guide part 11, so that dangerous movements (pulling out of the surgical hook 25 or action on the lens) may occur in the event of contact. It does not pass to 1.

FIG. 5 is a plan view showing a part of the eye 1 somewhat smaller than that of FIG.
The part 3 "of the iris 3 which has been partially pulled out is shown in this case. In this case, the surgical hook 25 is held in the transition part 5 by a disc-shaped fixing element 20.

FIG. 6 is an enlarged view of a front portion of the hook element 10 formed as the hook portion 15. Due to the above-mentioned heat treatment of the polyamide yarn, the strength in the region of the hook portion 15 is locally increased. However, this strength is such that in the first phase, the hook portion 15 pulls the portion 3 "of the iris 3 to the outer edge (FIG. 5), as shown in FIG.

In the second phase, the surgical hook 10 is moved inward, especially in the direction opposite to the direction of the arrow Z, whereby the part 3 "of the iris 3 is diminished (the hooking part 15 is connected to the iris 3). Is disengaged), and the surgical hook 10 is about 70
It is rotatable around its longitudinal axis by ~ 90 °. Subsequently, the surgical hook 10 is pulled in the arrow Z direction. When the end surface 13 ′ of the leg 13 of the hook-shaped hooking portion 15 comes into contact with an inner transition (not shown) from the cornea 2 to the sclera 7 and is further pulled in the arrow Z direction, the hook-shaped hooking portion 15 is moved. Is bent and stretched so that the surgical hook 10 can be pulled out as a long thread. As soon as the thread has been completely pulled out, an incision (not shown) formed in the cornea 2 closes in a self-sealing manner.

However, starting from the state shown in FIG.
The surgical hook 10 can be removed by further pulling the guide portion 11 in the direction of arrow Z. in this case,
Further, due to the rigidity of the portion 3 ″ to be pulled, the hook portion 1
As shown in FIG. 6, 5 is bent and stretched, moves to the original extended position (two-dot chain line portions 12 ', 13'), and is pulled out of the eye. Thereby, also in this case, the surgical hook 25
Immediately after removal, the incision in the cornea 2 closes in a self-sealing manner.

Referring to the dimensions of the surgical hook 25 according to the invention, the overall length of the hook element 10 is on the order of about 5 to 8 mm and the length of the bent hook part 15 is 1.
It is on the order of 0 to 1.5 mm. The total width of the curved portion 12 is
It is on the order of 0.4 to 0.5 mm. The polyamide yarn has a profile profile of, for example, a circular cross section and is about 0.15 to 0.2 m.
m.

Due to the rigidity of the hooking portion 15 which is limited by the bending range of the hooking portion, the iris 3 ″ is in the hooked state and in the further pulled state (FIG. 4), and the hooking portion 15 is in the unhooked state (FIG. 4). (Not shown)
The surgical hook 25 according to the invention, which fully bends and stretches the hook portion 15, can be withdrawn from the eye 1 without any problem. At this time, the incision of the cornea 2 does not undesirably expand due to tearing. The incision in the cornea 2 is a surgical hook 25
After closing, close in a self-sealing manner.

FIGS. 7 to 10 show the operation hook 2 from the eye 1.
Important phases of the different states when withdrawing 5 are shown in an enlarged manner. The actuation method described below for removing the surgical hook 25 is a preferred variant of the method for removing the surgical hook 25.

FIG. 7 is a horizontal sectional view of the eye 1 along FIG. 4, showing the cornea 2, the iris 3 having both areas 3 ', 3 ", the sclera 7, the lens 4, the pupil 4' and the ciliary ligament 6. , 6 'The surgical hook 25 is different from that of Fig. 4, and as shown in Fig. 7, the leg portion 13 of the hooking portion 15 is the portion 3 "of the iris 3.
Is moved in the direction of arrow Z 'so as to deviate from the position.

In the next phase, the surgical hook 25 is rotated in the direction of arrow D by about 70 to 90 ° about its longitudinal axis X ', as shown in FIG. Then, the surgical hook 25
Is pulled in the arrow Z direction as shown in FIG.

As shown in FIG.
When the end face 13 ′ of the leg 13 contacts the not-shown inner transition from the cornea 2 to the sclera 7 and is further pulled in the direction of the arrow Z, the hook-shaped hooking part 15
As shown at 0, the surgical hook 10 is stretched so that it can be pulled out of the eye 1 as a long, substantially straight thread.

[0030]

As described above, the surgical hook according to the present invention requires only a small incision to be made in the cornea for insertion into the eye. Furthermore, the thread-like guiding portion of the surgical hook is self-sealingly surrounded by the corneal wall separated by the incision during the operation. Furthermore, when a suitable tensile load is applied to the guide part in order to remove the surgical hook, the hook-shaped hooking part is automatically opened, so that the hook element can be pulled out of the eye as a long thread. Furthermore, after removal of the surgical hook, the additional incision of the incision is no longer necessary, as the incision in the cornea is closed in a self-sealable manner, while at the same time preventing unwanted drainage of aqueous humor. is there. Furthermore, since the thread-shaped guide portion which is longer than the hook portion has sufficient elasticity, there is an advantage that the eye is not injured by an unexpected contact of the operator.

[Brief description of the drawings]

FIG. 1 is an enlarged side view of a hook element for a surgical hook.

FIG. 2 is a side view of a surgical hook including the hook element of FIG. 1 and a fixing element provided thereon.

FIG. 3 is a plan view of the surgical hook as viewed from the direction of arrow III in FIG. 2;

4 is a schematic enlarged horizontal cross-sectional view of a part of an eye showing a state where the surgical hook of FIG. 2 is pulled in a range of an iris.

FIG. 5 is a plan view showing an eye in which the iris is partially pulled, which is smaller than that of FIG. 4;

6 shows a part of the hook element for a surgical hook according to FIG. 2, with the hook-shaped hooking part in a fully opened or extended state.

FIG. 7 is a schematic enlarged horizontal sectional view showing a part of an eye together with a surgical hook at the time of extraction.

FIG. 8 is a schematic enlarged horizontal sectional view showing a part of the eye with different phases of the surgical hook at the time of withdrawal.

FIG. 9 is a schematic enlarged horizontal sectional view showing a part of an eye with different phases of a surgical hook at the time of withdrawal;

FIG. 10 is a schematic enlarged horizontal sectional view showing a part of an eye with different phases of a surgical hook at the time of withdrawal;

[Explanation of symbols]

 Reference Signs List 1 eye 2 cornea 3 iris 10 hook element 11 guide part 15 hook part 20 fixing element 22 contact part 23,23 'hole 25 surgical hook

Continuing on the front page (72) Inventor Dyson Hickbottom, United States, 27503, North Carolina, Colombia, Barhama, 9805 (56) Reference US Pat. No. 5,174,279 (US, A) (58) Fields investigated (Int. Cl. ⁷ , DB name) A61F 9/007

Claims (8)

(57) [Claims] 1. A hook element (10) and a fixing element (20).
The hook element having at least one end with a hook-shaped hook portion (1) for locally pulling the iris (3).
5) and a long guide part (11), the fixing element is slidably mounted on the guide part (11), and the surgical hook (25) inserted through the incision in the cornea (2) is fixed. In a surgical hook for use during a surgical operation on a living eye (1), which is held on the outer contour of the eye (1) by an element, a hook element (10) integrally forms the hook part (15). Made of a flexible thermoplastic synthetic resin, the hooking portion (15) has a limited stiffness at least in the bending range, and this stiffness causes the iris (3 ") with the hooking portion hooked on the iris. ) Is further pulled to prevent the resistance acting on the hook portion (15) or the hook portion (15) by the cornea (2) with the hook portion removed from the iris.
Is smaller than the resistance acting on the hook (25), so that when the surgical hook (25) is withdrawn from the eye (1), the bending range of the hooking portion (15) can be bent and stretched to a sufficiently straight state by the resistance. Surgical hook characterized by the following. 2. The surgical hook according to claim 1, wherein the hook-shaped hooking part is integrally formed on the hook element by heat treatment. 3. The surgical hook according to claim 1, wherein the hook element (10) with the integral hook part (15) is made of polyamide thread. 4. The fixing element (20) is formed as a flexible disc, said disc comprising at least two holes (23, 23 ') spaced apart from one another with respect to the axis of symmetry,
2. The surgical hook according to claim 1, wherein the guide portion of the thread-like hook element is insertable through the hole. 5. The fastening element (20) comprises a hook element (10).
It has a characteristic rigidity in a state fitted in the fixing member, and the fixing element (20) which can be adjusted in the longitudinal direction on the guide portion (11) can be self-tightened to an arbitrary position by the characteristic rigidity. The surgical hook of claim 4, wherein 6. A two-spaced part, in which, in the fitted state, the locking element is compressible on one side of the guide part (11) for adjustment of the locking element (20). 21, 21 ′) and on the other side an arc-shaped contact (22), the fixing element (20) being the contact (22)
Surgical hook according to claim 4 or 5, held and supported in the eye (1) by an eye. 7. Holes (23, 23 ') with fixing elements (20) spaced apart and oriented transversely to the surface.
5. Surgical device according to claim 4, characterized in that the plate-shaped fixing element (20) is formed as a plate formed with a flexible material and the outer shape of the plate-shaped fixing element (20) is circular, oval, square or rectangular. hook. 8. The fixing element according to claim 4, wherein the fixing element is made of silicone rubber or the like.
7. The surgical hook according to any one of 7 above.